[Axe]

**I have done searches for plantar fasciitis, plantar, and heel spur here. I have done my due diligence in searching other internet sites and Pubmed as well.

Please excuse the drawn out story here. I figured it is better to lay everything out to make it easier for anyone who reads this who might have suggestions as to what I should do next.

I am a 41 y/o male, 6'00". was 235 lbs, am now 250 due to lack of exercise. I am having issues with Recalcitrant Plantar Fasciitis.

For a number of years, I walked 3-6 miles per day. I walked on asphalt road surfaces during snow season and on soft ground when the snow wasn't covering the ground.

I did not run, nor did I ruck. I have had an ACDF, and could use a laminectomy as well, but am trying to avoid it if possible, so I avoid jarring or strong weight hanging from my back/neck/shoulders.

In April 2009, I started developing very minor (1/10) pain bilaterally in my dorsal calcaneal region that was present only during exercise. I was already taking Mobic 15 for the neck and a right ankle which has minor OA.

I reduced my walking to 1-2 miles per day,began icing and elevating after activity, and started doing some minor stretching.


By July 2009, despite the measures I was taking, my pain was at 5-6/10 when walking, 4/10 at rest 24-48 hrs following any necessary walking of more than 1/8 of a mile. I began to notice that standing for more than 6 hours caused pain equivalent to the pain caused by ambulation.

I stopped walking for exercise and avoided other walking and unnecessary standing except when absolutely necessary. I continued icing, elevating, and stretching. I also then developed s/s of minor Achilles Tendonitis in my left ankle.

I made a visit to one of the best Orthopods in the area in January (Team Doc for the Packers). He gave me pain medication to get me through the SHOT Show, gave me a Medrol Dose Pack to be followed with Voltaren in place of Mobic, and Rxed Physical Therapy. The Medrol pack helped for the time I was on it, but then lost its efficacy.

I did physical therapy, which consisted of stretching and ultrasound treatment on the heels. The ultrasound made a huge difference for 24-48 hours, relieving pain completely. By the next appointment, necessary daily walking would cause the pain to recur, and the ultrasound treatment would remove it again.

The PT stretching relieved the Achilles Tendonitis, and I gained flexibility in the foot, soleus, gastro, and other muscles/tendons of the ankle, but did not achieve relief of the plantar fasciitis pain issues.

At this point, walking more than 1/8 mile or standing for more than one hour caused pain 7-8/10. The ultrasound was like a magic wand, but wouldn't last past two days of minor activity.

I underwent Cortisone injections in both heels in late May 2010, which gave significant (roughly 99%) relief of pain, allowing normal ambulation. I avoided any serious walking, but was able to handle being Scoutmaster at Boy Scout camp in July (1-2 miles per day walking at a fairly slower pace), get a mile or so of normal up and down office work ambulation weekdays and outdoor chores on weekends, and able to remain standing for more than 4-6 hours without extreme discomfort. I was able to remain standing without severe pain well enough to cut up and split 3 cords of wood, which was my major chore goal for the summer, and get my son through his Eagle Scout project ( 4 days X 12 hrs per day of standing/walking.)

About a week ago, I needed to walk approximately one mile on soft ground. 48 hours later, I was at a 8/10 pain level when walking, 6/10 pain level standing, and an intermittent 4-5/10 pain level when at rest. I am back to no activity, ice, elevation, stretching.

I visited the Orthopod 2 days ago. He is confounded at the lack of improvement. He did not want to do more Cortisone injections because of the pf rupture risk. He wrote me another script for PT, a script for night splints, and wrote me a script for painkillers for my upcoming family vacation to Yellowstone next week.

I have tried different shoes, and different OTC orthotic inserts. Nothing has really worked. I have pretty much exhausted the options I can think of short of surgery, which I know is a last resort and beset with morbidity issues all its own. My Orthopod strongly recommends against it as well since it causes so many arch issues.

I have read some research about a technique called dry needling, which involves repeated jabbing of the plantar fascia followed by ultrasound-guided injection of Cortisone. The reported results sound promising, but I can find little detailed information on the procedure studies and protocols. (I can only read abstracts on Medline as I do not have an account). I also can not find a lot of people who perform the procedure using internet searches, which leaves me questioning the true efficacy of the procedure. My Orthopod had never heard of it.

I would like to regain the ability to ambulate for normal daily activity. I would also like to be able to exercise by walking. I am willing to travel for treatment if I need to see someone with special expertise.

Does anyone have any suggestions as to how I should proceed? I am running out of ideas.